The Care Quality Commission
  • Doctor
  • GP practice

Morrab Surgery

Overall: Good read more about inspection ratings

2 Morrab Road, Penzance, Cornwall, TR18 4EL (01736) 363866

Provided and run by:
Morrab Surgery

All Inspections

22 February 2022

During an inspection looking at part of the service

We carried out an announced focused inspection at Morrab surgery on 22 February 2022. The practice had previously been inspected in December 2019, when it was rated good overall with the exception of effective which was rated as requires improvement. This was because the domain was affected by ratings of two population groups; working age people and people experiencing poor mental health.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Morrab Surgery on our website at www.cqc.org.uk

Why we carried out this inspection

We undertook this inspection at the same time as CQC inspected a range of urgent and emergency care services in Cornwall. To understand the experience of GP Providers and people who use GP services, we asked a range of questions in relation to urgent and emergency care. The responses we received have been used to inform and support system-wide feedback.

How we carried out the inspection

Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included:

  • Conducting staff interviews using video conferencing
  • Completing clinical searches on the practice’s patient records system and discussing findings with the provider
  • Reviewing patient records to identify issues and clarify actions taken by the provider
  • Requesting evidence from the provider
  • A site visit

Our findings

We based our judgement of the quality of care at this service on a combination of:

  • what we found when we inspected
  • information from our ongoing monitoring of data about services and
  • information from the provider, patients, the public and other organisations.

We have rated this practice as Good overall

We found that:

  • The practice provided care in a way that kept patients safe and protected them from avoidable harm.
  • Patients received effective care and treatment that met their needs.
  • Staff dealt with patients with kindness and respect and involved them in decisions about their care.
  • The practice adjusted how it delivered services to meet the needs of patients during the COVID-19 pandemic. Patients could access care and treatment in a timely way.
  • The way the practice was led and managed promoted the delivery of high-quality, person-centred care.
  • Staff had completed training relevant to their role.
  • The practice routinely reviewed the effectiveness and appropriateness of the care provided.

Whilst we found no breaches of regulations, the provider should:

  • Have a formal process to demonstrate how they assured the competence of staff employed in advanced clinical practice, for example, nurses, paramedics, pharmacists and physician associates.
  • Continue to increase the uptake of cervical screening and childhood immunisations.
  • Have a documented process for recording the cold chain from vaccines entering the premises to being refrigerated.
  • Support and promote the development of the Patient Participation Group (PPG).

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

During a routine inspection

We carried out an announced comprehensive inspection at Morrab Surgery on 4 December 2019 to follow up on breaches of regulations. The practice had previously been inspected in May 2019, when it was rated Inadequate overall. Specifically, the practice was rated as inadequate for providing safe and well-led services. The practice had been rated as requires improvement for providing effective services and good for providing caring and responsive services. The practice was placed in special measures. This was because of ineffective governance systems and shortfalls regarding fire safety, health and safety, staff training and safe use and storage of medicines.

We based our judgement of the quality of care at this service on a combination of:

  • what we found when we inspected
  • information from our ongoing monitoring of data about services and
  • information from the provider, patients, the public and other organisations.

We have rated this practice as good overall and for each domain, with the exception of effective which was rated as requires improvement. This was because the domain was affected by the rating of two population groups; working age people and people experiencing poor mental health, which were rated as requires improvement. All other population groups were rated as good.

We found that:

  • The practice had implemented systems which promoted health and safety, including fire safety and infection prevention and control.
  • There were clear and effective processes for managing and mitigating risks which included risk assessment, action planning and auditing systems to ensure adherence with the practice’s policies and local and national guidelines.
  • The practice was able to demonstrate safe use and storage of medicines, including medicines that required refrigeration and protocols utilised within the dispensary.
  • The majority of staff had completed necessary training. All outstanding training was due to be completed by the end of December 2019.
  • Patients received effective care and treatment that met their needs.
  • The practice routinely reviewed the effectiveness and appropriateness of the care it provided.
  • Staff dealt with patients with kindness and respect and involved them in decisions about their care.
  • The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
  • The practice had implemented systems of good governance which included coherent delegation and overview of tasks, action planning and effective audit of those systems.

Whilst we found no breaches of regulations, the provider should:

  • Keep records of schedule three Controlled Drugs in accordance with national guidance.
  • Continue to increase the uptake of cervical screening and childhood immunisations.
  • Improve the documentation of agreed care plans for people experiencing poor mental health.
  • Ensure all relevant staff have completed equality and diversity training and Mental Capacity Act (2005)

This service was placed in special measures in May 2019. Sufficient improvements have been made such that Morrab Surgery has now been rated as Good. I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

During an inspection looking at part of the service

Previously we carried out an announced comprehensive inspection at Morrab Surgery on 15 May 2019.

We served a warning notice to the provider following a breach of regulations 17; Good governance, of the Health and Social Care Act 2008. We also issued a requirement notices in relation to regulation 12, Safe care and treatment, and regulation 18; Requirements in relation to staffing. Following our inspection in May 2019, the practice was rated as Inadequate overall and placed into special measures.

We carried out an announced focused inspection at Morrab Surgery on 3 July and found that the requirements of the warning notice had been met. As this was to check compliance with the warning notice, the ratings from the previous inspection in May 2019 have not been changed.

We based our judgement of the quality of care at this service on a combination of:

  • what we found when we inspected
  • information from our ongoing monitoring of data about services and
  • information from the provider, patients, the public and other organisations.

At this inspection we found that arrangements relating to good governance had been reviewed where needed to improve care, but there were still some actions remaining.

We found that:

  • Systems to support fire safety had been implemented effectively. External fire risk assessments had been completed, the practice had started to undertake required actions.
  • Policies and procedures had been implemented to ensure medicines and equipment were safely stored and monitored.
  • Patient Group Directives (PGDs) were safely used to administer medicines.
  • Infection prevention and control systems had been updated to ensure potential risks were identified.
  • There was an overview of staff training, there had been an improvement in necessary training completed for staff. However, not all staff had completed all necessary training, including safeguarding adults, safeguarding children, fire safety and infection prevention and control. The practice planned to complete training for all staff as soon as possible.
  • Nominated staff had oversight of newly implemented systems and had been given protected time to monitor compliance in accordance to policies and procedures.

Whilst we found no breaches of regulations, the provider should:

  • Continue to review governance systems to ensure policies implemented are imbedded.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

During a routine inspection

We carried out an announced inspection on 11 March 2015. There was one area followed up in a desktop reviewed on 26 November 2015. The practice was rated as outstanding overall.

We undertook a focused follow up inspection on 29 November 2018. The purpose of the inspection was to review actions taken by the practice to safeguard patients following a serious incident of fraudulent activity investigated by the police. At this inspection we identified a breach of Regulation 17 (HSCA)relating to good governance.

We carried out an announced comprehensive inspection at Morrab Surgery on 15 May 2019.

At this inspection we followed up on breaches of regulations identified at a previous inspection on 29 November 2018.

We based our judgement of the quality of care at this service on a combination of:

  • what we found when we inspected
  • information from our ongoing monitoring of data about services and
  • information from the provider, patients, the public and other organisations.

We have rated this practice as inadequate overall.

We rated the practice as inadequate for providing safe services because:

  • The practice did not have clear systems and processes to keep patients safe.
  • Appropriate standards of cleanliness and hygiene were not met.
  • The practice did not have appropriate systems in place for the safe management of medicines.
  • There were shortfalls in learning when things went wrong.

We rated the practice as requires improvement for providing effective services because:

  • The practice was unable to show that staff had the skills, knowledge and experience to carry out their roles.

These areas affected all population groups so we rated all population groups as requires improvement.

We rated the practice as inadequate for providing well-led services because:

  • While the practice had made some improvements since our inspection on 29 November 2018, and had addressed the Requirement Notice in relation to good governance, at this inspection we also identified additional concerns that put patients at risk.
  • The overall governance arrangements were ineffective.
  • The practice did not have clear and effective processes for managing risks, issues and performance.

We rated the practice as good for providing caring and responsive services because:

  • Staff dealt with patients with kindness and respect and involved them in decisions about their care.
  • The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.

The areas where the provider must make improvements are:

  • Ensure that care and treatment is provided in a safe way.
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
  • Ensure persons employed in the provision of the regulated activity receive the appropriate training necessary to enable them to carry out the duties.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

  • Continue to review systems to maintain overview of action taken following safety alerts.
  • Review arrangements to improve the uptake of cervical screening.

I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration.

Special measures will give people who use the service the reassurance that the care they get should improve.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

29 November 2018

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Morrab Surgery on 11 March 2015. There was one area followed up in a desktop reviewed on 26 November 2015. The overall rating for the practice was outstanding, with other ratings listed at the beginning of the report. The full comprehensive report can be found by selecting the ‘all reports’ link for Morrab Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 29 November 2018. The purpose of the inspection was to review actions taken by the practice to safeguard patients following a serious incident of fraudulent activity investigated by the police.

We did not rate the practice at this inspection. This will be reviewed at the next routine comprehensive inspection.

Are services well-led?

We found that this service was providing well-led care in accordance with the relevant regulations. However, there were areas of governance where improvement was required. The practice demonstrated safeguards were now in place resulting from the serious incident: Limiting prescribing and issuing of scripts for medications by authorised clinical staff only. Increased security of prescription stationary was in place. Staff had a clear understanding of their roles and responsibilities regarding patient prescriptions.

Our key findings were:

  • There was immediate notification and liaison with appropriate authorities (Care Quality Commission, NHS England and Nurses, Midwife Council) after the practice was made aware of unusual prescribing activity.
  • Processes were put in place limiting access within the prescribing part of the patient record system to allow only authorised clinical staff who held a prescribing qualification to prescribe medicines.
  • Duty of candour requirements were followed with affected patients being informed about the incident, with records of any actions taken.
  • The practice worked closely with the police during their investigation and court case.
  • Risk assessments were completed for additional prescription security and locks purchased for printers to secure prescription stationary.
  • Gaps were seen in governance processes where mitigating actions to reduce risks had not been followed up. The practice did not have an effective audit system to determine whether improvements and changes made were embedded. A risk assessment covering prescription security and new procedures were written within 48 hours of the inspection covering authorisation and initiation of combined oral contraception, dispensary and reception tasks regarding acute prescriptions.
  • An inconsistent approach was seen regarding which process should be followed for complaints and significant events, which could be confusing and affect the governance of these processes by the practice.

The areas where the provider must make improvements are:

  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

There were areas where the provider could make improvements and should:

  • Keep policies and procedures for prescribing management under review to ensure current best practice guidance is followed to reduce risks.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

26 November 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out a desktop review of Morrab Surgery on 26 November 2015. This was to review the actions taken by the provider as a result of our issuing a legal requirement.

Overall the practice has been re-rated as OUTSTANDING following our findings.

Our key findings across all the areas we inspected were as follows:

  • The provider had established and is operating effective recruitment procedures to ensure that information regarding pre-employment checks are kept regarding persons employed.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

11 March 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Morrab Surgery on 11 March 2015. The practice has a small branch surgery at Mousehole, where patients with minor concerns are seen. This inspection focussed on the Morrab Surgery. Overall the practice is rated as GOOD.

Specifically, we found the practice to be outstanding for caring and responsive services. The practice was good for providing effective and well led services, but required improvement to safety. It was good for providing services for older people, working age people and people with mental health needs including dementia and people with long term conditions. It was outstanding for and families, babies children and young people and vulnerable people.

Our key findings across all the areas we inspected were as follows:

  • Patient contentment at Morrab Surgery was significantly higher with 100% expressing overall satisfaction with the practice. Patients they were treated with “exceptional” compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • There was a strong commitment to providing person centred, well co-ordinated, responsive and compassionate care for patients.
  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
  • Risks to patients were assessed and well managed.
  • Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
  • Information about services and how to complain was available and easy to understand.
  • Patients said they found it easy to make an appointment with a named GP and that there was continuity of care. Urgent appointments were available the same day and staff were flexible and found same day gaps for patients needing routine appointments.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
  • Audits were used by the practice to identify where improvements were required. Action plans were put into place, followed through and audits repeated to ensure that improvements had been made.
  • The practice had clear policies and procedure providing guidance for staff. However, we found that the recruitment policy had not been adhered to and needed improvement.

We saw areas of outstanding practice including:

  • The practice understood the needs of the patient list and the challenges of the coastal location and had developed a responsive service accordingly. There were many examples of this seen at the inspection. For example, Morrab Surgery is strongly committed to breaking down barriers for vulnerable people, including homeless people who are valued, made welcome and very well supported. Extended appointments were made available immediately so thorough health assessments of homeless people could be done and treatment provided where appropriate.
  • Staff are consistent in supporting people live healthier lives through a targeted and proactive approach. For example, the practice is focussed on working with young people to reduce the number of unplanned pregnancies. The practice is an approved Young people friendly service and able to provide friendly, confidential support that is focussed on the needs of young people. Statistics for the practice showed that the number of unplanned births to women under 18 years had fallen slightly from 5 in 2010 to 2 in 2014 and 1 in 2015. A dedicated young person clinic is run once a week after school hours and information at the practice and website is aimed at young people providing contraception and sexual health advice, support and treatment.

However there were areas of practice where the provider needs to make improvements.

Importantly the provider must:

Establish and operate effective recruitment procedures to ensure that information regarding pre-employment checks is kept.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice